Despite narrowing the gap, racial disparities persist in liver transplantation, mortality
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Key takeaways:
- Black and Hispanic patients were less likely to undergo liver transplantation vs. white patients.
- In 2018, mortality rates remained higher among Black patients.
Disparities in receipt of liver transplantation and mortality persisted over time among hospitalized Black and Hispanic patients with decompensated cirrhosis compared with their white counterparts, according to data in JAMA Network Open.
“There had been no characterization of disparities in receipt of inpatient procedures for cirrhosis in over a decade,” Lauren D. Nephew, MD, MSCE, assistant professor of gastroenterology and hepatology and associate vice chair of health equity at Indiana University School of Medicine, told Healio. “Yet, there have been significant changes in the epidemiology of liver disease, efforts to improve cirrhosis care quality and policy changes, like Medicaid expansions to help improve access to care.”
Nephew continued: “We were interested in understanding what progress, if any, has been made toward improving disparities in the care of vulnerable racial and ethnic minorities.”
Using data from the Healthcare Cost and Utilization Project National Inpatient Sample, Nephew and colleagues conducted a retrospective, cross-sectional study on 717,580 cirrhosis admissions among patients (median age, 58 years) with portal hypertension-related complications from 2009 to 2018. Researchers noted 47.4% of patients were white, 17.6% were Hispanic and 9.8% were Black.
Studied outcomes included receipt of lifesaving procedures, including upper endoscopy, transjugular portosystemic shunt (TIPS), hemodialysis and LT, as well as mortality rates stratified by race and ethnicity over time.
“There is good news and bad news,” Nephew said. “The good news is there were no racial and ethnic disparities in the receipt of upper endoscopy for variceal bleeding. In addition, the disparity in the receipt of LT and survival improved some for Black and Hispanic patients over the study period.”
However, she noted that “while the gap narrowed,” Black patients remained less likely to undergo TIPS for variceal hemorrhage (OR = 0.54; 95% CI, 0.47-0.62) and ascites (OR = 0.34; 95% CI, 0.31-0.38) compared with white patients. Further, although there was improvement, both Black (OR = 0.66; 95% CI, 0.61-0.7) and Hispanic (OR = 0.74; 95% CI, 0.7-0.78) patients remained less likely to undergo LT.
“We know that the social determinants of health are critical to being able to access LT,” Nephew told Healio. “The social determinants of health are not evenly distributed across populations, so inadequate insurance, social support or recent substance use may be playing a role. I would be doing a disservice to not mention bias and racism and the role that these factors may play in accessing health care services.”
Researchers also reported that while the odds of death decreased in Black and Hispanic patients during the study period, they remained higher in 2018 among Black patients (OR = 1.08; 95% CI, 1.05-1.11) vs. white patients.
“Now that we have an updated description of where we are, I believe we can begin to understand the why and act simultaneously,” Nephew said. “There are practical lessons that can be drawn from disparities work in other fields and things we can do now. For example, culturally tailored decision support tools may help racial and ethnic minority patients better understand their treatment options.”
She continued: “Physician communication interventions that help with culturally tailored communication and trust-building may improve the uptake of procedures when they are offered.”
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